Delaware Volunteer Fire Service Revolving Loan Fund Application

The Delaware Volunteer Fire Service Revolving Loan Fund was established to upgrade equipment and improve facilities that are essential to providing adequate fire, rescue, emergency medical and technical emergency response related service to Delaware communities. Loan funds are limited and are not available for equipment that has already been delivered or for the expansion of facilities and parking that has already been completed. For consideration, equipment and expansions must be deemed necessary to provide adequate fire, rescue and emergency medical and technical emergency response services to the surrounding community by the Delaware Council on Volunteer Fire Service. See the Program Guidelines for additional information.

PLEASE NOTE: One original copyof the application should be delivered to State of Delaware, Dept. of Finance, Office of the Secretary, 820 N. French Street, 8th floor, Wilmington, DE 19801.

  1. General Information
  1. Applicant’s Legal Name and Mailing Address

______

______

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  1. County: ______3. Applicant’s Federal Tax I.D. #: ______

4. Name/Position of Contact Person: ______

  1. Mailing Address, if different: ______

______

  1. E-mail Address: ______
  2. Phone Numbers: (identify home/work/pager/cell) ______

The following information will be considered for prioritizing loan applications.

  1. Organizational Profile
  1. Name of applicant’sprimary protection district:______
  2. Population of applicant’s primary protection district:______
  3. Square Miles of applicant’s primary protection district:______
  1. Checklist of Financial Information to include with application

___ Compilation Review and Audit Report, for two years preceding the year of application. Include a copy of confirmation letter that most recent audit has been submitted to the State Fire Prevention Commission.

  1. ___ Proposed Operating and Capital Budgets, for two years preceding the year of application
  2. ___ IRS Form 990, for two years preceding the year of application
  3. ___ Inventory of applicant’s assets
  4. ___ Company’s Resolution to Procure and Borrow for Requested Asset
  5. ___ List of Company Officers
  6. Please describe any income, revenue or other financial support from any source not reflected in the financial statements, for example, in-kind services, energy or city services provided by an outside source.______
  7. Describe Asset to Be Acquired

VEHICLES AND APPARATUS

Part 1Describe asset to be acquired

New Used Rehabilitated Vehicle

AdditionReplacement

Rescue Truck Heavy Rescue Aerial Pumpers Ambulance

Light Duty Rescue Watercraft Rescue Other Used Apparatus

Year ______Make ______Model ______

Tank cap./gal ______Pumping cap./gal ______Ladder/ft. ______

If used:

Odometer ______Vehicle ID#______

Part 2 Describe asset to be replaced, if applicable

Rescue Truck Heavy Rescue Aerial Pumpers Ambulance

Light Duty Rescue Watercraft Rescue Other Used Apparatus

Year ______Make ______Model ______

Odometer ______Vehicle ID#______

Tank cap./gal ______Pumping cap./gal ______Ladder/ft. ______

Part 3 Describe vehicle to be rehabilitated/repaired as well as rehabilitation efforts, if applicable

Rescue Truck Heavy Rescue Aerial Pumpers Ambulance

Light Duty Rescue Watercraft Rescue Other Used Apparatus

Year ______Make ______Model ______

Odometer ______Vehicle ID#______

Does vehicle meet applicable NFPA Standards? ______

______

EQUIPMENT

New

Accessory EquipmentCommunications Equipment Personal Protective Equipment

Accessory equipment:any equipment used to support fire rescue and EMS; for example; hoses, saws and fans. List the type of accessory, communications or personal protective equipment being acquired:

______

FACILITY

New Construction ModernizationRenovation/Repair

Describe the organization’s existing facilities and explain why they are inadequate. Describe the construction, renovations, repairs or modernization that is planned. If the facility address is, or will be different from the address listed in Section A of this application, please indicate the new address. Attach plans and detailed estimates of construction costs.

______

  1. Estimate of Contract or Bid Cost: ______
  2. Purpose of Loan Request:

Buy new apparatus/equipment/facility Refinance existing apparatus/equipment/facility

  1. Amount of Loan Requested: ______
  2. Term of Loan Requested: ______
  3. Repayment Option (circle one): Semi-Annually /Annually
  4. How will the proposed expenditure be funded if the loan application is denied? ______

______

  1. Other Funding sources and types (Loan/Allocation/Donation or Grant)

Source / Amount / Type / Expected Loan Rate
Self-funding / ______/ ______ / ______
Bank or other lending institution / ______/ ______ / ______
Municipality / ______/ ______ / ______
Relief Assoc./Org. or Individual / ______/ ______ / ______
Other ______/ ______/ ______ / ______

25. Please describe both your need for the apparatus, equipment or facility proposed as well as your need for a DVFS revolving loan. Attach a separate page, if necessary.

______

______

______

______

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  1. Signature/Certification

We, the undersigned and duly authorized officers of ______do hereby certify that the information presented in this application, including all attachments, is true and accurate and that we are authorized by Resolution to apply for a loan and to borrow from the Delaware Volunteer Fire Service Revolving Loan Fund. Said Resolution, in the form attached, is signed, sealed and submitted with this application.

Name: Date

Signature of Volunteer Company President

Name: Date

Signature of Volunteer Company Secretary

(Affix Corporate Seal)

Year / Type / Make/Model / Year
Purchased / Cost / Estimated
Value

______

______

______

______

______

______

______

______

______

RESOLUTION TO PROCURE AND BORROW FOR REQUESTED ASSET

I, ______, an officer of ______, certify that the corporate officers of this organization have been authorized to procure ______. Said officers are also authorized to file an application to borrow money in the amount of $______from the Delaware Volunteer Fire Service Revolving Loan Fund. Minutes from the relevant meeting of the board are attached.

______

Signature of Company Officer Date

______

Signature of Company Secretary Date

(Affix Company Seal)

Revised 1/31/18